Form 1 Screener

Appendix H:

Telephone Screener

OMB No.: 0925-xxxx

Expiration Date: xx/xx/20xx

NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN

Public reporting burden for this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0642). Do not return the completed form to this address.

“Thank you for your interest in the research study. The purpose of the Solar Cell study is to design a smart phone application, which uses smart phone technology to aid users in protecting their skin from damaging ultraviolet radiation (UV) in sunlight, a primary cause of skin cancer.

To see if you might qualify for this study, I need to ask you some questions. You do not have to answer any questions you do not want to answer”.

Screening Questions:

Do you own an Android smart phone?

______ <<If no, discontinue. If yes, continue.>>

Would you be willing to download and install and application on your smartphone and use it for three months?

______ <<If no, discontinue. If yes, continue.>>